Spontaneous Renal Artery Dissection: Characteristics, Course, Associations

Afshinnia, Farsad, M.D., M.S.
Research Fellow and Clinical Lecturer
Department of Nephrology
University of Michigan Health System

MedicalResearch.com: What are the main findings of the study?

Answer: Spontaneous Renal Artery Dissection (SRAD) is most commonly observed in middle aged individuals. Although SRAD can have no association with other comorbidities at the time of presentation, we have noticed association with a number of systemic disorders such as hypertension, cancer, congestive heart failure, and rheumatologic diseases. In particular clustering of Fibromascular dysplasia (FMD), Ehlers-Danlos syndrome, poly arteritis nodosa, Poland syndrome, and nail patella syndrome in our patients has been striking. The most commonly observed presenting symptom is sudden onset severe flank pain which may be spontaneous or following physical stress. Other presenting features may include uncontrolled hypertension, groin and/or testicular pain, headache, nausea, vomiting, fever, dysuria, hematuria and blurry vision.

MedicalResearch.com: Were any of the findings unexpected?

Answer: Association with a cluster of systemic disorders in our observation was quite unexpected and striking. Although uncontrolled hypertension at presentation may be reflection of pain or Renin-Angiotensin-Aldosterone System (RAAS) activation due to disrupted renal blood flow, history of longstanding hypertension even prior to dissection may reflect underlying vascular disorders such as FMD.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer: For patients: If sudden onset severe unremitting flank pain is experienced patients should seek urgent medical attention. Upon confirmation of SRAD, avoidance of strenuous physical activities such as heavy weight lifting is advised as recurrence of SRAD is not uncommon. Control of hypertension as a modifiable risk factor may protect against recurrence of SRAD.

For physicians: Radiographic imaging should confirm the diagnosis once SRAD is suspected. Confirmation is made by conventional renal artery angiography, CT angiogram or Magnetic Resonance Angiography (MRA). Presence of SRAD should draw physician’s attention to possible presence of other systemic disorders, and initiation of appropriate work up. Treatment options include supportive medical treatment (such as control of pain, blood pressure, management of coexistent symptoms ± anticoagulation), endovascular radiographic interventions (such as stenting), and surgical repair (including vascular reconstruction, anastomosis, and nephrectomy). Choice of therapy is individualized and is determined by severity and extent of dissection. Long term prognosis is a function of underlying comorbid conditions, although with appropriate medical or surgical management, long-term clinical outcome may appear favorable.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer: SRAD may present sporadically. It may also be complication of other rare diseases. Our study besides several other case series and reports has suggested some of these rare diseases. However, foundation of consortium of SRAD allowing global registry of this entity may provide opportunity for its better understanding by shedding more light to its hidden aspects.